Chronic Obstructive Pulmonary Disease (COPD): Treatment

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Chronic obstructive pulmonary disease (COPD) is the most common chronic disease of the airways that is caused in 90 % of cases by smoking. COPD is a preventable and treatable disease. However, many patients do not know that they suffer from the disease, so the number of unreported cases of patients is very high. In this article, you will find important information on the epidemiology, etiology, pathophysiology and diagnosis, as well as the differential diagnosis and treatment of COPD.

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increased FEV1 to FVC ratio and usually
a fall in transfer factor as well.
00:01
Treatment of COPD. Well most obviously and very clearly
the patient needs to stop smoking. As I showedin the diagram earlier, a patient who develops
COPD who is diagnosed early and is encouragedto stop smoking, that is the single most important
thing that will happen for their health benefit.
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That will put them onto a situation where
their lung function will decline slower andthey are much less likely to develop respiratory
failure and death later in life. The othermajor treatment is pulmonary rehabilitation,
and this is an exercise and educational programmewhich teaches the patient about their disease
and makes them actually more capable of doingtheir exercise within the constraints of their
disease. It’s a structured exercise programmethat encourages them to use their lungs more
than they would do in normal life and thatgives them the facility, that sort of fitness
to cope with their COPD better; and thirdlywe use inhalers. To be honest, the
treatment with inhalersis a little bit adhoc and random when it comes
to patients with COPD. We start off with shortacting B2-agonists as bronchodilators or antimuscarinics
such as ipratropium, salbutamol or ipratropium.
01:14
Initially we use the short acting versions,
if the patients respond well to those we maygive them a little long acting versions of
those. And then if they are having more severedisease we might give them a combination of
a long acting B2-agonists and a long actingantimuscarinics. The use of inhaled steroids.
These are used in combination with long actingbronchodilators and that’s really normally
reserved for patients with more severe diseaseor those patients who are clearly progressing
in an attempts to dampen down the inflammationthat must be driving down that progression
of their disease or those patients presentingwith frequent exacerbations of their COPD
in the hope that the inhaled steroid componentwill make those exacerbations less frequent.
Because they are controlled to trial data showingthat inhaled steroids can reduce the frequency
of exacerbations in patients with COPD.
02:10
The problem with COPD is that, unlike asthma the
inhaled steroid is not particularly effectiveagainst the inflammation. Other therapies
that you can consider are oraltheophyllines as an oral bronchodilator, it
can be very useful and is an oral mucolyticscan be used to thin the phlegm and allow the
patient to cough up their phlegm more readily.
02:29
There are data now showing that low dose long-term
antibiotics can be very beneficial and weuse those in selected patients who are poorly
controlled with frequent exacerbations forexample. And some patients, and I emphasize
the word ‘some’ here, some patients withvery bad disease may benefit from oral corticosteroids
on a long term basis. Corticosteroids areused as an oral treatment for exacerbations
and are known to reduce the duration of anexacerbation and some patients feel that their
breathing is clearly better when they aretaking an oral corticosteroids, and that when
they come off it, they deteriorate. And thosepatients with severe disease, we might consider
a low dose, but that is only in a very smallminority because the complications of oral
corticosteroid therapy, as discussed in theasthma lecture, are major. Surgery.
Now is a little bit counter-intuitivethat surgery might be beneficial for somebody
who has a diffused lung disease such as COPD,however there are specific circumstances where
surgery could be useful. For example if youhad a single large bullae that showed a CT
scan earlier of somebody that had a rightsided large bullae, you could resect that
bullus and that will allow the underlyinglung to expand more and that may improve the
lung function. If somebody has the pneumothoraxbecause of their COPD, a secondary pneumothorax,
then that's quite likely that pneumothoraxwill need surgical treatment to heal the
bronchopleural fistula that's formed.
04:04
And then there's lung volume reduction surgery.
Now this is not used in many patients, butin a minority of patients, if you resect the
redundant the emphysematous lobes, and theytend to be at the upper lobes in most patients
with COPD, then that allows the remainingless emphysematous lung to expand and perhaps
function better. So there are controlled trialdata showing that lung volume reduction surgery
does lead to improved lung function and a slightimprovement in the patient's breathlessness.
And finally, for patients with severe COPDwho are relatively young, you may consider
lung transplantation as a potential cure fortheir disease. Chronic severe COPD leads to
respiratory failure. The patient will becomehypoxic, and they may, as a consequence, need
long term oxygen therapy and the normal criteriafor that is that if they have an arterial
PaO2 of less than 7.2. When they are well andstable, then we will consider them for long
term oxygen therapy, and that's used for 15hours a day. Throughout the night when they
are asleep and also when there are at homeduring the day. And it's known that LTOT (long
term oxygen therapy), used in these patientswith chronic hypoxia improves survival. And
this is thought to be because of effects onreducing the negative consequences of
cor pulmonale.
05:34
In addition, patients with chronic type 2
respiratory failure might be suitable foran overnight non-invasive ventilation being
used at home. And then when patients do developcor pulmonale, that needs to be treated with
diuretics and potentially, although only veryrarely it is in practice that it is done,
they might be given pulmonary artery basedvasodilators such as Sildenafil. Right, so
the next section of this talk is going to

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